Ultrasonographic measurement of shoulder subluxation in patients with post-stroke hemiplegia

Abstract

Objective: To evaluate the ultrasonographic measurement of shoulder subluxation in patients with post-stroke hemiplegia. Design: Prospective, single blind study. Patients: A total of 41 patients with post-stroke hemiplegia were included (24 men and 17 women, mean age 56 years (standard deviation 11), age range 34-78 years). Methods: Clinical evaluation of the affected shoulder was assessed using the Motricity Index scores and the Modified Ashworth Scale. Two ultrasonographic measurements were taken to check intra-rater reliability. The shoulder subluxation ratio was determined as the ratio of the radiographic vertical and horizontal distance, and the ultrasonographic lateral and anterior distances in the affected shoulder divided by that in the unaffected shoulder. Results: Intraclass correlation coefficients of the repeated ultrasonographic lateral/anterior distance measurements in the unaffected and affected shoulders were 0.979/0.969 and 0.950/0.947, respectively. Ultrasonographic lateral/anterior distance ratios were negatively correlated with Motricity Index scores of the affected shoulder abduction (r = -0.490, p < 0.001/ r = -0.671, p < 0.001). Ultrasonographic anterior distance ratio was negatively correlated with Modified Ashworth Scale score of the affected shoulder (r = -0.374, p < 0.05). However, there was no correlation between radiographic distance ratios and clinical evaluation scores. Conclusion: We strongly recommend ultrasonography as a diagnostic tool to measure the degree of shoulder subluxation in patients with post-stroke hemiplegia.

Bedside ultrasonography of musculoskeletal complications in brain injured patients

“…US can easily performed at the bedside, can measure inferior and anterior shoulder subluxation with high reproducibility and correlation with clinical scores and it can be used for serial evaluations without exposure to ionizing radiations [20]. In our series US two cortical fractures could be diagnosed.…”

Intra-rater and inter-rater reliability of ultrasonographic measurements of acromion-greater tuberosity distance in patients with post-stroke hemiplegia

“…16 These values suggest that the mean differences between the two raters did not have an effect on the reliability coefficients, however is of more concern in the consideration of validity. For the purpose of standardization, however, it is critical that all raters measure the AGT distance using the same bony reference points.…”

“…Another study compared ultrasound with the fingerbreadth palpation method and it reports good agreement between these two methods highlighting the potential clinical utility of the ultrasound method. 18 Although there were differences in the measurement procedure, high reliability coefficients (ICC =0.979 to 0.98) reported from these studies 16,17 suggest that ultrasonographic measurements are reliable when measured by the same rater.…”

“…6,7,13 Radiographs are considered to be objective, and have high reliability and validity, More recently, diagnostic ultrasound has also been used for the assessment of GHS in people with post-stroke hemiplegia by measuring the acromion-greater tuberosity (AGT) distance between the lateral border of the acromion and the apex of the greater tuberosity of the humerus. 16,17 Using a large, static ultrasound machine Park et al 16 report high intra-rater reliability (ICC = 0.979) of ultrasound measurements of GHS undertaken with patients seated in the upright sitting position with arms dependent in a neutral position, without the arm support.…”

Ultrasonographic assessment of neuromuscular electrical stimulation efficacy on glenohumeral subluxation in patients with hemiplegia: a randomized-controlled study

“…[1] It mostly occurs in hemiplegic patients as an inferior subluxation with an incidence of 17 to 81%. [2][3][4] Supraspinatus and posterior deltoid muscles contribute to the shoulder stabilization, and they prevent the inferior subluxation. [1] Severe impairment of motor function, particularly in these muscles, after stroke is a potential risk factor for subluxation.…”